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Psychiatry Flashcards

1
Q

what are the theories about what causes schizophrenia?

A

Psychoanalytic- severe breakdown of the ego
Behavioural- reinforcement, observational learning and shaping affect development of schizophrenia
Cognitive- schizophrenia is severely irrational thinking

Biological-dopamine, structural defects in brain, genetic influences

Stress-vulnerability model- a biological sensitivity or vulnerability to a certain disorder will develop under the right conditions of environmental or emotional stress.

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2
Q

What is the lifetime risk of schizophrenia?

A

1% in general population

8-10% risk in siblings

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3
Q

What are the two main parts of the stress response?

A

The sympathetic nervous system

The limbic hypothalamo pituitary adrenal axis

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4
Q

What are the components of the limbic system?

A 
Hippocampus
Septal area
Amygdala
Prefrontal cortex
Cingulate gyrus
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5
Q

What is the hippocampus?

A

A curved piece of cortex which is folded into the medial surface of the temporal lobe.

It is involved in memory and expressions of emotion.

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6
Q

What is the amygdala?

A

Collection of nuclei next to hippocampus which drives related behaviours and processing of associated emotions.

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7
Q

What effect does the sympathetic nervous system have in the stress response?

A

Increased heart rate and force of contraction

Dilated bronchi

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8
Q

What is general adaptation syndrome?

A

Alarm reaction causes NA release from sympathetic nerves
Adrenaline and noradrenaline release from adrenal medulla
Cortisol release from adrenal cortex.

Resistance- action of cortisol is longer lasting than adrenaline- allowing maintenance of response to stress.

Exhaustion- prolonged stress causes continued cortisol secretion leading to muscle wastage, suppression of immune system and hyperglycaemia.

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9
Q

What are the different kinds of anxiety disorders?

A 
Social phobias
Specific phobias
Generalised anxiety disorder
Panic disorder
OCD
PTSD
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10
Q

What is theory of how anxiety disorders are generated?

A

Decreased levels of GABA in cortex. Increasing levels of serotonin may stimulate serotonin receptors in hippocampus leading to neuroprotection, neurogenesis and reduction of anxiety.

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11
Q

What is the mainstay of treatment for anxiety disorders?

A

SSRIs
CBT
Pregabalin- is a GABA analogue.

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12
Q

What is an obsession?

A

A thought that persists and dominates an individuals thinking despite their awareness that the thought is without purpose, or has dominated their thinking beyond the point of relevance or usefulness.

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13
Q

What are compulsions?

A

Obsessional motor acts. May result from obsessional impulse that leads directly to action, or they may be mediated by an obsessional mental image.

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14
Q

What are the diagnostic criteria for OCD?

A

Obsessions/ compulsions/ both are present on most days for a period of 2 weeks.

These:
Originate in mind of patient
Acknowledged as excessive or unreasonable
Patient tries to resist but at least one obsessions/ compulsion is unsuccessfully resisted.

Carrying out thought or act is not pleasurable
They must cause distress or interfere with patients social or individual functioning.

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15
Q

When do OCDs usually begin?

A

In adolescence or early adulthood

33% start between 10-15 years old

75% started by age 30

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16
Q

What is the prevalence of OCD in an individuals lifetime?

A

2%

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17
Q

What is the suggested pathophysiology of OCD?

A

Re-entry ciruits in basal ganglia

Reduced serotonin

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18
Q

What is PANDAS-

Paediatric autoimmune neuropsychiatric disorder associated with streptococcal infection?

A

Sudden onset of OCD symptoms or tics after infection with group A beta haemolytic strep.
Usually dramatic onset of psychiatric or behavioural problems.

Antibodies cross react with neurons in basal ganglia causing symptoms.

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19
Q

What are the core symptoms of depression (3)

A

Low mood
Lack of energy
Anhedonia- lack of enjoyment in things you would have previously been interested in

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20
Q

What is the difference between an adjustment reaction and depression?

A

Adjustment reaction- symptoms develop suddenly
Symptoms fluctuate
Time limited
Preoccupation with event

Depression- symptoms develop gradually, continuous, usually> 2 weeks, lack of interest/ energy.

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21
Q

What are some illnesses that can cause depression?

A

Hormone disturbance such as thyroid dysfunction
Vitamin deficiencies such as vit B12

Heart and lung disease

Blood vessel disease

Kidney disease

Liver disease

Alcohol misuse

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22
Q

Which brain structures are involved in depressive symptoms?

A

Limbic system
Frontal lobe
Basal ganglia

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23
Q

What are the different components of the limbic system?

A 
Cingulate gyrus
Hippocampus
Amygdala
Hypothalamus
Septum
Olfactory bundle
Dentate gyrus
Anterior nucleus of thalamus
Mammillary bodies
24
Q

What are the main functions of the limbic system

A

Emotion
Motivation
Memory

25
Q

Which adrenaline receptors are thought to be involved in arousal and mood?

A

A1 and a2.

26
Q

What is the evidence that noradrenaline is implicated in depression?

A

AMPT inhibits tyrosine to L-DOPA which causes depressive symptoms.

Antidepressants such as NARI, TCAs and SNRIs improve depressive symptoms.

27
Q

What is the role of serotonin in the brain?

A

Sleep
Impulse control
Appetite
Mood

28
Q

Where is serotonin produced in the brain?

Where is it transported?

A

In the brain stem raphe nuclei

It is transported to cortical areas and limbic system

29
Q

What causes people to become clinically depressed?

A

Predisposing- genetics, childhood experiences, female gender

Perpetuating factors- stressful job, studies, relationship difficulties, substance misuse, financial strain, housing

Precipitating factors- loss of family member, loss of health and breakup of relationships.

30
Q

What is psychosis?

A

The presence of hallucinations or delusions.

31
Q

What are hallucinations?

A

Perception without a stimulus. Can be in any sensory modality. Visual hallucinations are usually organic.

32
Q

What kinds of hallucinations exist in the normal population?

A

Hynogogic- going to sleep

Hypnopompic- waking up

33
Q

What is a delusion?

A

Abnormal belief outside of cultural norms and is unshakeable.

34
Q

What are first rank symptoms?

A

Auditory hallucinations
Passivity experiences-patient believes action or feeling is caused by an external force.
Thought withdrawal, broadcast or insertion
Delusional perceptions-attribution of new meaning to an object
Somatic hallucinations- mimics feeling from inside the body

35
Q

What are positive symptoms of schizophrenia?

A

Delusions, hallucinations, thought disorder, lack of insight

36
Q

What are negative symptoms of schizophrenia?

A

Underactivity, low motivation, social withdrawal, emotional flattening, self neglect

37
Q

What is the ICD10 diagnosis for schizophrenia?

A

At least one of:

Thought echo, insertion, withdrawal, broadcast
Delusions of control, influence of passivity
Hallucinatory voices
Persistent delusions of other kinds that are culturally inappropriate

Or 2 of:
Persistent hallucinations in any modality
Neologisms- breaks in train of thought
Catatonic behaviour
Negative symptomssuch as marked apathy, paucity of speech

38
Q

What is paranoid schizophrenia?

A

Delusions or hallucinations are most prominent

39
Q

What is simple schizophrenia?

A

Loss of drive and interest, aimlessness, idleness, self absorbed attitude and social withdrawal.

NO hallucinations/delusions

40
Q

What is hebephrenic schizophrenia?

A

Definite and sustained flattening or shallowness, aimless and disjointed behaviour. Hallucinations/delusions must not dominate

41
Q

What is undifferentiated schizophrenia?

A

Insufficient symptoms to meet criteria of any subtypes or so many symptoms fit more than one criteria.

42
Q

What are the three parts of the brain that are thought to be affected in schizophrenia?

A

Dopamine pathways
Brain changes
Limbic system

43
Q

What are the 3 main dopamine pathways in schizophrenia?

A

Mesocortical pathway
Mesolimbic pathway
Nigrostriatal pathway

44
Q

Where do both the mesocortical and mesolimbic pathway originate?

A

In the ventral tegmental area

45
Q

Where does the mesolimbicpathway project?

A

To the limbic system and the nucleus accumbens. This is thought to be overactive in schizophrenia

46
Q

Where does the mesocortical pathway project?

A

To the frontal cortex and cingulate cortex.

This is thought to be underactive in schizophrenia

47
Q

What brain changes can be detected in schizophrenia?

A

Enlarged ventricles

Reduced hippocampal formation, amydgala, parahippocampal gyrus and prefrontal cortex.

48
Q

How do typical antipsychotics work?

A

Block D2 receptors in all CNS dopaminergic pathways

Main action in mesolimbic and mesocortical pathways.

49
Q

How do atypical antipsychotics work?

A

Low affinity for D2 receptors. Therefore milder side effects as they rapidly dissociate from D2 receptor.

50
Q

What kind of receptor is D2?

A

A Gi coupled receptor.

51
Q

Why do antipsychotics cause movement problems?

A

They act on basal ganglia pathways and prevent stimulation of cortex.

52
Q

What is catatonia?

A

Stupor/mutism

Excitement

Posturing
Negativism

Rigidity

Waxy flexibility

Command automatism

53
Q

what is the prognosis of schizophrenia?

A

Mortality is twice as high as in general population
Shorter life expectancy
Higher incidence of CVs disease, respiratory disease and cancer as they often smoke more

Suicide risk is 9 times higher than in general population

Death from violent incidents is twice as high

54
Q

What is drug induced psychosis?

A

Psychosis induced by a psychoactive substance
Eg methamphetamine, cocaine, cannabis, amphetamines, LSD, ecstasy, ketamine.

Must meet the ICD 10 criteria: onset of psychotic symptoms during or wihtin two weeks of substance use
Persistence of psychotic symptoms from more than 48 hours
Duration of disorder not exceeding 6 months.

55
Q

What is affective psychosis?

A

Psychotic experiences are normally congruent with mood.

Eg. Manic patients may have grandiose delusions- eg hear god speaking to them

Depressed patients may have delusions of guilt or nihilism, unpleasant auditory hallucinations.

56
Q

What is post partum psychosis?

A

Affects 1 in 1000 women

Very severe and needs to be recognised quickly
Can present in patients with no previous psychiatric history
More comon if previous bipolar disorder or psychotic illness
Onset within days to weeks of delivery

Neuro (18 decks)

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